Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | S8337 | TX |
NPI | 1154778595 |
---|---|
Provider Name | Manju Mathew |
First Address | Dallas, TX 75284-7208 |
Second Address | Dallas, TX 75390-7419 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2016 |
Last Update Date | 01/02/2021 |